Maternal and child health services in the United States.
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Biomedical subjects
Publications and source records attributed to M Wagner.
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By speaking over the heads of handicapped people we reveal our underlying beliefs and assumptions regarding mental and physical perfection. We must challenge such beliefs if we are to appreciate the important contribution the disabled make to society and we must provide services for them which respect and empower them rather than further disable them.
Among the side effects of endoscopy, cardiopulmonary complications are particularly important. This risk appears to be greatest in endoscopic retrograde cholangio- and pancreaticography (ERCP) because of the patient's prone position, iv sedatives and analgetics and the relatively long duration of the examination. We studied 75 patients (50 patients without and 25 patients with premedication) who were to undergo ERCP and looked at these data: age, weight, premedication, accompanying diseases, reason for this examination, blood count, oxygen saturation SaO2 (pulse oximeter), pulse, blood pressure and length of the examination. Overall, the oxygen saturation decreased considerably and two patients only had 69%. Pulse rate increased and one patient had 205 beats per minute, one 172. We looked for a correlation between SaO2, pulse rate and blood pressure and studied the patients' usual medication, the length of the ERCP, the indication for ERCP, age and hemoglobin. There was no correlation. But all patients suffering from a compromised cardiopulmonary status had received a rather heavy premedication and the ERCP was longer than in other patients. Since it is not clear which patients may develop cardiopulmonary complications, it is advisable to monitor all patients by pulse oximeter in order to avoid these complications. This seems also advisable because the rooms where the examination takes place are darkened and the patient is in a prone position so he cannot be seen clearly.
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As hospitals face increasing pressure to rein in costs, equipment spending faces stiff competition for limited funds. When facilities replace aging or outdated equipment, they're often replacing the entire technology assessment process as well. One hospital facing a $4 million bill to equip a new building is revamping its purchasing process based on department "wish lists." And an Ohio system has formed a special division to speed assessment and implementation of new technologies and procedures.
Purchasing for hospitals unable or not inclined to convert to stockless inventory, consignment can offer some of the same savings on inventory costs without imposing extra computer and tracking needs on materials management.
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Community hospitals increasingly are entering the cardiac-care business, with hopes of enhancing their public image, increasing revenues and winning managed-care contracts. But some question whether advanced services such as cardiac catheterization and open-heart surgery are profitable for smaller hospitals, or even medically appropriate.
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A major study commissioned by the Health Industry Distributors Assn. finds a lot of merit in the conversion of hospitals to stockless inventory. But it also finds a lot of resistance and barriers.
While many American healthcare supply companies already do business in a global market, the European Community's impending switch to a single-market system and the radical changes in Eastern European countries in recent months should spell increased opportunities overseas. However, as European trade barriers come down, the level of competition is likely to go up, both at home and abroad.
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More hospitals are trying to save on in-house staff costs by contracting out for equipment maintenance. But some experts say the short-term gain in operating dollars may not be worth the long-term cost. Prospects for savings depend on how well the service contracts are managed.
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Hospital-based physicians usually are in a position to make big profits while the host facility springs for the overhead costs of equipment. Republic Health Corp. is altering the status quo by making the physicians pay for their own equipment in return for long-term security.